P80Combined assessment of the fetal distress in diabetic pregnancy class R/F using uterine, middle cerebral, umbilical artery blood flow and fetal heart rate monitoring

Abstract

BackgroundPregnacies complicated by diabetes mellitus cl.R/F are in higher risk of placentae insufficiency and poor perinatal outcome.MethodsWe have investigated 15 diabetic pregnant women of class R/F after 26 weeks of pregnancy. We observed waveform ‘notch’ in ascending uterine artery. Fetal distress was diagnosed when, in the nst silent oscilation or late decelarations appeared. Pathological blood flow in term pregnancy was diagnosed when RI and PI was abnormal and cerebro‐placental ratio was above 1. AEDF and REDF were assessed as fetal distress. Newborns were estimated by Apgar score and pH value of umbilical artery. The mean diurnal glycemia ranged 110 mg/dl, and the HbA1c 6.2%, 8.0%.ResultsPathological condition acc. to the AS and pH A.umb. manifested 75% newborns, but acc. only to pH A.umb.values 15% of them. Positive predictive value of NST in fetal distress detection was 66%, of the DV 53%, uterine artery ‘notch’ 66% when neonates condition was analysed by using AS and pH. The highest (80%) PPV was achieved all methods. False positive results in NST analysis were found in 19.8% of cases. False negative results was for methods together in 6.6%. When the neonates condition was analysed only by using pH A.umb.value, the PPV for NST was 66%, for DV 73%, for ‘notch’ 73% and for all methods together 86%. False positive results for all methods NST, DV, ‘notch’: and for all methods tohether, achieved the following values: 26%, 19.8%, 19.8% and 26%. False negative result in all methods was 6.6%.ConclusinsBlood flow measurements in fetal and maternal circulatory circles combined with FHR monitoring reaches very high prognostic values in detection of the fetal distress.